Abstract
Background: Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither eff ort quantified uncertainty in prevalence or years lived with disability (YLDs). Methods: Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis. Findings: Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350 000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coefficient -0·37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa. Interpretation: Rates of YLDs per 100 000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantification of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Eff ective and aff ordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world.
Original language | English |
---|---|
Pages (from-to) | 2163-2196 |
Number of pages | 34 |
Journal | The Lancet |
Volume | 380 |
Issue number | 9859 |
DOIs | |
State | Published - 2012 |
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In: The Lancet, Vol. 380, No. 9859, 2012, p. 2163-2196.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010
T2 - A systematic analysis for the Global Burden of Disease Study 2010
AU - Vos, Theo
AU - Flaxman, Abraham D.
AU - Naghavi, Mohsen
AU - Lozano, Rafael
AU - Michaud, Catherine
AU - Ezzati, Majid
AU - Shibuya, Kenji
AU - Salomon, Joshua A.
AU - Abdalla, Safa
AU - Aboyans, Victor
AU - Abraham, Jerry
AU - Ackerman, Ilana
AU - Aggarwal, Rakesh
AU - Ahn, Stephanie Y.
AU - Ali, Mohammed K.
AU - Almazroa, Mohammad A.
AU - Alvarado, Miriam
AU - Anderson, H. Ross
AU - Anderson, Laurie M.
AU - Andrews, Kathryn G.
AU - Atkinson, Charles
AU - Baddour, Larry M.
AU - Bahalim, Adil N.
AU - Barker-Collo, Suzanne
AU - Barrero, Lope H.
AU - Bartels, David H.
AU - Basáñez, Maria Gloria
AU - Baxter, Amanda
AU - Bell, Michelle L.
AU - Benjamin, Emelia J.
AU - Bennett, Derrick
AU - Bernabé, Eduardo
AU - Bhalla, Kavi
AU - Bhandari, Bishal
AU - Bikbov, Boris
AU - Abdulhak, Aref Bin
AU - Birbeck, Gretchen
AU - Black, James A.
AU - Blencowe, Hannah
AU - Blore, Jed D.
AU - Blyth, Fiona
AU - Bolliger, Ian
AU - Bonaventure, Audrey
AU - Boufous, Soufiane
AU - Bourne, Rupert
AU - Boussinesq, Michel
AU - Braithwaite, Tasanee
AU - Brayne, Carol
AU - Bridgett, Lisa
AU - Brooker, Simon
AU - Brooks, Peter
AU - Brugha, Traolach S.
AU - Bryan-Hancock, Claire
AU - Bucello, Chiara
AU - Buchbinder, Rachelle
AU - Buckle, Geoffrey
AU - Budke, Christine M.
AU - Burch, Michael
AU - Burney, Peter
AU - Burstein, Roy
AU - Calabria, Bianca
AU - Campbell, Benjamin
AU - Canter, Charles E.
AU - Carabin, Hélène
AU - Carapetis, Jonathan
AU - Carmona, Loreto
AU - Cella, Claudia
AU - Charlson, Fiona
AU - Chen, Honglei
AU - Cheng, Andrew Tai Ann
AU - Chou, David
AU - Chugh, Sumeet S.
AU - Coffeng, Luc E.
AU - Colan, Steven D.
AU - Colquhoun, Samantha
AU - Colson, K. Ellicott
AU - Condon, John
AU - Connor, Myles D.
AU - Cooper, Leslie T.
AU - Corriere, Matthew
AU - Cortinovis, Monica
AU - De Vaccaro, Karen Courville
AU - Couser, William
AU - Cowie, Benjamin C.
AU - Criqui, Michael H.
AU - Cross, Marita
AU - Dabhadkar, Kaustubh C.
AU - Dahiya, Manu
AU - Dahodwala, Nabila
AU - Damsere-Derry, James
AU - Danaei, Goodarz
AU - Davis, Adrian
AU - De Leo, Diego
AU - Degenhardt, Louisa
AU - Dellavalle, Robert
AU - Delossantos, Allyne
AU - Denenberg, Julie
AU - Derrett, Sarah
AU - Des Jarlais, Don C.
AU - Dharmaratne, Samath D.
AU - Dherani, Mukesh
AU - Diaz-Torne, Cesar
AU - Dolk, Helen
AU - Dorsey, E. Ray
AU - Driscoll, Tim
AU - Duber, Herbert
AU - Ebel, Beth
AU - Edmond, Karen
AU - Elbaz, Alexis
AU - Ali, Suad Eltahir
AU - Erskine, Holly
AU - Erwin, Patricia J.
AU - Espindola, Patricia
AU - Ewoigbokhan, Stalin E.
AU - Farzadfar, Farshad
AU - Feigin, Valery
AU - Felson, David T.
AU - Ferrari, Alize
AU - Ferri, Cleusa P.
AU - Fèvre, Eric M.
AU - Finucane, Mariel M.
AU - Flaxman, Seth
AU - Flood, Louise
AU - Foreman, Kyle
AU - Forouzanfar, Mohammad H.
AU - Fowkes, Francis Gerry R.
AU - Franklin, Richard
AU - Fransen, Marlene
AU - Freeman, Michael K.
AU - Gabbe, Belinda J.
AU - Gabriel, Sherine E.
AU - Gakidou, Emmanuela
AU - Ganatra, Hammad A.
AU - Garcia, Bianca
AU - Gaspari, Flavio
AU - Gillum, Richard F.
AU - Gmel, Gerhard
AU - Gosselin, Richard
AU - Grainger, Rebecca
AU - Groeger, Justina
AU - Guillemin, Francis
AU - Gunnell, David
AU - Gupta, Ramyani
AU - Haagsma, Juanita
AU - Hagan, Holly
AU - Halasa, Yara A.
AU - Hall, Wayne
AU - Haring, Diana
AU - Haro, Josep Maria
AU - Harrison, James E.
AU - Havmoeller, Rasmus
AU - Hay, Roderick J.
AU - Higashi, Hideki
AU - Hill, Catherine
AU - Hoen, Bruno
AU - Hoffman, Howard
AU - Hotez, Peter J.
AU - Hoy, Damian
AU - Huang, John J.
AU - Ibeanusi, Sydney E.
AU - Jacobsen, Kathryn H.
AU - James, Spencer L.
AU - Jarvis, Deborah
AU - Jasrasaria, Rashmi
AU - Jayaraman, Sudha
AU - Johns, Nicole
AU - Jonas, Jost B.
AU - Karthikeyan, Ganesan
AU - Kassebaum, Nicholas
AU - Kawakami, Norito
AU - Keren, Andre
AU - Khoo, Jon Paul
AU - King, Charles H.
AU - Knowlton, Lisa Marie
AU - Kobusingye, Olive
AU - Koranteng, Adofo
AU - Krishnamurthi, Rita
AU - Lalloo, Ratilal
AU - Laslett, Laura L.
AU - Lathlean, Tim
AU - Leasher, Janet L.
AU - Lee, Yong Yi
AU - Leigh, James
AU - Lim, Stephen S.
AU - Limb, Elizabeth
AU - Lin, John Kent
AU - Lipnick, Michael
AU - Lipshultz, Steven E.
AU - Liu, Wei
AU - Loane, Maria
AU - Ohno, Summer Lockett
AU - Lyons, Ronan
AU - Ma, Jixiang
AU - Mabweijano, Jacqueline
AU - MacIntyre, Michael F.
AU - Malekzadeh, Reza
AU - Mallinger, Leslie
AU - Manivannan, Sivabalan
AU - Marcenes, Wagner
AU - March, Lyn
AU - Margolis, David J.
AU - Marks, Guy B.
AU - Marks, Robin
AU - Matsumori, Akira
AU - Matzopoulos, Richard
AU - Mayosi, Bongani M.
AU - McAnulty, John H.
AU - McDermott, Mary M.
AU - McGill, Neil
AU - McGrath, John
AU - Medina-Mora, Maria Elena
AU - Meltzer, Michele
AU - Memish, Ziad A.
AU - Mensah, George A.
AU - Merriman, Tony R.
AU - Meyer, Ana Claire
AU - Miglioli, Valeria
AU - Miller, Matthew
AU - Miller, Ted R.
AU - Mitchell, Philip B.
AU - Mocumbi, Ana Olga
AU - Moffitt, Terrie E.
AU - Mokdad, Ali A.
AU - Monasta, Lorenzo
AU - Montico, Marcella
AU - Moradi-Lakeh, Maziar
AU - Moran, Andrew
AU - Morawska, Lidia
AU - Mori, Rintaro
AU - Murdoch, Michele E.
AU - Mwaniki, Michael K.
AU - Naidoo, Kovin
AU - Nair, M. Nathan
AU - Naldi, Luigi
AU - Narayan, K. M.Venkat
AU - Nelson, Paul K.
AU - Nelson, Robert G.
AU - Nevitt, Michael C.
AU - Newton, Charles R.
AU - Nolte, Sandra
AU - Norman, Paul
AU - Norman, Rosana
AU - O'Donnell, Martin
AU - O'Hanlon, Simon
AU - Olives, Casey
AU - Omer, Saad B.
AU - Ortblad, Katrina
AU - Osborne, Richard
AU - Ozgediz, Doruk
AU - Page, Andrew
AU - Pahari, Bishnu
AU - Pandian, Jeyaraj Durai
AU - Rivero, Andrea Panozo
AU - Patten, Scott B.
AU - Pearce, Neil
AU - Padilla, Rogelio Perez
AU - Perez-Ruiz, Fernando
AU - Perico, Norberto
AU - Pesudovs, Konrad
AU - Phillips, David
AU - Phillips, Michael R.
AU - Pierce, Kelsey
AU - Pion, Sébastien
AU - Polanczyk, Guilherme V.
AU - Polinder, Suzanne
AU - Pope, C. Arden
AU - Popova, Svetlana
AU - Porrini, Esteban
AU - Pourmalek, Farshad
AU - Prince, Martin
AU - Pullan, Rachel L.
AU - Ramaiah, Kapa D.
AU - Ranganathan, Dharani
AU - Razavi, Homie
AU - Regan, Mathilda
AU - Rehm, Jürgen T.
AU - Rein, David B.
AU - Remuzzi, Guiseppe
AU - Richardson, Kathryn
AU - Rivara, Frederick P.
AU - Roberts, Thomas
AU - Robinson, Carolyn
AU - De Leòn, Felipe Rodriguez
AU - Ronfani, Luca
AU - Room, Robin
AU - Rosenfeld, Lisa C.
AU - Rushton, Lesley
AU - Sacco, Ralph L.
AU - Saha, Sukanta
AU - Sampson, Uchechukwu
AU - Sanchez-Riera, Lidia
AU - Sanman, Ella
AU - Schwebel, David C.
AU - Scott, James Graham
AU - Segui-Gomez, Maria
AU - Shahraz, Saeid
AU - Shepard, Donald S.
AU - Shin, Hwashin
AU - Shivakoti, Rupak
AU - Silberberg, Donald
AU - Singh, David
AU - Singh, Gitanjali M.
AU - Singh, Jasvinder A.
AU - Singleton, Jessica
AU - Sleet, David A.
AU - Sliwa, Karen
AU - Smith, Emma
AU - Smith, Jennifer L.
AU - Stapelberg, Nicolas J.C.
AU - Steer, Andrew
AU - Steiner, Timothy
AU - Stolk, Wilma A.
AU - Stovner, Lars Jacob
AU - Sudfeld, Christopher
AU - Syed, Sana
AU - Tamburlini, Giorgio
AU - Tavakkoli, Mohammad
AU - Taylor, Hugh R.
AU - Taylor, Jennifer A.
AU - Taylor, William J.
AU - Thomas, Bernadette
AU - Thomson, W. Murray
AU - Thurston, George D.
AU - Tleyjeh, Imad M.
AU - Tonelli, Marcello
AU - Towbin, Jeffrey A.
AU - Truelsen, Thomas
AU - Tsilimbaris, Miltiadis K.
AU - Ubeda, Clotilde
AU - Undurraga, Eduardo A.
AU - Van Der Werf, Marieke J.
AU - Van Os, Jim
AU - Vavilala, Monica S.
AU - Venketasubramanian, N.
AU - Wang, Mengru
AU - Wang, Wenzhi
AU - Watt, Kerrianne
AU - Weatherall, David J.
AU - Weinstock, Martin A.
AU - Weintraub, Robert
AU - Weisskopf, Marc G.
AU - Weissman, Myrna M.
AU - White, Richard A.
AU - Whiteford, Harvey
AU - Wiersma, Steven T.
AU - Wilkinson, James D.
AU - Williams, Hywel C.
AU - Williams, Sean R.M.
AU - Witt, Emma
AU - Wolfe, Frederick
AU - Woolf, Anthony D.
AU - Wulf, Sarah
AU - Yeh, Pon Hsiu
AU - Zaidi, Anita K.M.
AU - Zheng, Zhi Jie
AU - Zonies, David
AU - Lopez, Alan D.
AU - Murray, Christopher J.L.
N1 - Funding Information: The following individuals would like to acknowledge various forms of institutional support. J P Abraham, B Bartels, and P Yeh recognize the support of the World Bank Global Road Safety Facility and Department of Global Health & Population, Harvard School of Public Health, and the World Health Organization Violence and Injury Prevention. B Bikbov acknowledges support from the Moscow State University of Medicine and Dentistry, Moscow, Russia; Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russia; International Society of Nephrology. R Bourne acknowledges the Vision & Eye Research Unit, Postgraduate Medical Institute, Anglia Ruskin University, Cambridge, UK. S Brooker is supported by a Wellcome Trust Senior Fellowship in Basic Biomedical Science (098045) . T S Brugha received funding from the Department of Health London, for the National Health Service Information Centre, by the University of Leicester. R Buchbinder is partially funded by an Australian National Health and Medical Research Council (NHMRC) Practitioner Fellowship, Monash University and Cabrini Health. P Burney and D Jarvis acknowledge that the Chronic Respiratory Disease Group received support from the BUPA Foundation, who had no role in study design, data collection and analysis, interpretation of data, decision to publish, or preparation of the manuscript. C Cella, M Cortinovis, F Gaspari, V Miglioli, and N Perico on behalf of the entire Genitourinary Expert Group acknowledge the International Society of Nephrology (ISN). H Chen acknowledges that his participation in this study was in part supported by the intramural research program of the NIH, the National Institute of Environmental Health Sciences. L E Coffeng and W A Stolk received financial support from the Africa Programme for Onchocerciasis Control (WHO/APOC) for their work on onchocerciasis. B C Cowie received institutional support from the Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia. M Cross and L March acknowledge the University of Sydney (USYD); Institute of Bone and Joint Research, University of Sydney, Department of Rheumatology, Royal North Shore Hospital, St Leonards NSW 2065 Australia. N Dahodwala was supported by NIH grant K23 AG034236 and the Parkinson Council while working on this project. L Degenhardt is supported by an Australian NHMRC Senior Research Fellowship and funding to support her work for illicit drug dependence was provided by the Australian National Drug and Alcohol Research Centre of the University of New South Wales, Australia. R Dellavalle was supported by the US Department of Veterans Affairs while contributing to this study. S Derrett acknowledges the Health Research Council of New Zealand and the University of Otago for their support. V Feigin and R Krishnamurthi were supported by the National Institute for Stroke and Applied Neurosciences, AUT University. E Fevre acknowledges the Wellcome Trust for grant 085308 . W Hall was supported by an NHMRC Australia Fellowship. R Havmoeller was supported by a grant from the Swedish Research Council (#2011-1071) . D Hoy was supported by the Bill and Melinda Gates Foundation and the Australian National Health and Medical Research Council. K H Jacobsen was supported by the World Health Organization for her work on hepatitis A. N Kawakami notes that the collection of data ultimately used in this study was supported by the following grants: The World Mental Health Japan (WMH-J) is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013) from the Japan Ministry of Health, Labour, and Welfare . He would like to thank staff members, field coordinators, and interviewers of the WMH Japan 2002-2004 Survey. L L Laslett is supported by an Australian Government Australian Postgraduate Award. She also notes that the TasOAC study, the results of which were used in this research, was supported by the National Health and Medical Research Council of Australia; Arthritis Foundation of Australia; Tasmanian Community Fund; Masonic Centenary Medical Research Foundation, Royal Hobart Hospital Research Foundation, and University of Tasmania Institutional Research Grants Scheme. R Malekzadeh funding from research grant of Tehran University of Medical Sciences to do the related studies. R Matzopoulos acknowledges the two institutions that support his research work: South African Medical Research Council Burden of Disease Research Unit; and the University of Cape Town School of Public Health and Family Medicine. T Merriman acknowledges the Health Research Council of New Zealand. K Naidoo was supported by the Brien Holden Vision Institute. P Nelson was supported by the National Drug and Alcohol Research Centre (UNSW, Australia). R G Nelson acknowledges his research was supported in part by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases. C Olives was funded in part by the Biostatistics, Epidemiologic and Bioinformatic Training in Environmental Health Training Grant (ES015459) . D Ozgediz acknowledges the staff and collaborators at the Mulago Hospital and Makerere University in Kampala, Uganda. K Pesudovs received institutional support from Flinders University. R Room's position at the University of Melbourne and Turning Point Alcohol and Drug Centre is funded by the Foundation for Alcohol Research and Education and the Victorian Department of Health. J A Salomon received support from the Burke Global Health Fellowship while working on this study. U Sampson received funding support from the Harold Amos Medical Faculty Development Award of the Robert Wood Johnson Foundation and the Vanderbilt Clinical and Translational Scholars Award. L Sanchez-Riera acknowledges the Spanish Society of Rheumatology (Sociedad Española de Reumatología). M Segui-Gomez's participation was partly supported by funds from the European Center for Injury Prevention, Universidad de Navarra. E Smith acknowledges the Department of Health and Ageing, Commonwealth Government of Australia, Institute of Bone and Joint Research (IBJR), University of Sydney (USYD). G D Thurston was supported in part by Center grant ES00260 from the National Institute of Environmental Health Sciences . D J Weatherall was supported by the Wellcome Trust UK, the Medical Research Council UK and the Anthony Cerami and Ann Dunne Research Trust.
PY - 2012
Y1 - 2012
N2 - Background: Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither eff ort quantified uncertainty in prevalence or years lived with disability (YLDs). Methods: Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis. Findings: Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350 000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coefficient -0·37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa. Interpretation: Rates of YLDs per 100 000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantification of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Eff ective and aff ordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world.
AB - Background: Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither eff ort quantified uncertainty in prevalence or years lived with disability (YLDs). Methods: Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis. Findings: Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350 000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coefficient -0·37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa. Interpretation: Rates of YLDs per 100 000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantification of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Eff ective and aff ordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world.
UR - http://www.scopus.com/inward/record.url?scp=84871051576&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(12)61729-2
DO - 10.1016/S0140-6736(12)61729-2
M3 - Article
C2 - 23245607
AN - SCOPUS:84871051576
SN - 0140-6736
VL - 380
SP - 2163
EP - 2196
JO - The Lancet
JF - The Lancet
IS - 9859
ER -